Section 41- Overdentures

Handout
Abstracts
001. Miller, P. A. Complete dentures supported by natural teeth. J Prosthet Dent 8:924-928, 1959.
002. Morrow, R. M., et al. Tooth-supported complete dentures: An approach to preventive
prosthodontics. J Prosthet Dent 21:513-522, 1969.
003. Morrow, R. M., et al. Immediate interim tooth-supported complete dentures. J Prosthet Dent
30:695-700, 1973.
004. Dodge, C. A. Prevention of complete denture problems by the use of overdentures. J
Prosthet Dent 30:403-411, 1973.
005. Thayer, H. H. Overdentures and the periodontium. DCNA 24:369-377, 1980.
006. Crum, R. J. and Rooney, G. E. Alveolar bone loss in overdentures - 5 year study. J Prosthet
Dent 40:610-613, 1978.
007. Derkson, G. D. and MacEntee, M. M. Effect of 0.4% stannous fluoride gel on the gingival
health of overdenture abutments. J Prosthet Dent 48:23-26, 1982.
008. Toolson, L. B. and Smith, D. E. A five-year longitudinal study of patients treated with
overdentures. J Prosthet Dent 49:749-756, 1983.
009. Ullo, C. A. and Renner, R. P. Design considerations for a removable partial overdenture.
Compend Contin Educ Dent 5:15-19, 1984.
010. Casey, D, M. and Lauciello, F. R. A review of the submerged root concept. J Prosthet Dent
43:128-132, 1980.
Section 41: Overdentures
(Handout)
Definitions
Overdenture: a removable partial or complete denture that covers and rests on one or more
remaining natural teeth, roots, and/or dental implants; a prosthesis that covers and is partially
supported by natural teeth, tooth roots, and/or dental implants-called also overlay denture,
overlay prosthesis, superimposed, prosthesis.
Indications and contraindications (Morrow)

Indications:
- when a patient has four or less retainable teeth in an arch
- as a practical measure in preventive dentistry
- with benefit the following patients: malrelated ridge cases; those facing the loss of teeth in one
arch while the other is dentulous; patients with unfavorable tongue positions, muscle
attachments, residual ridges; and difficult stablility/retention cases.
Contraindications:
- the patient who cannot be motivated to the desired level of oral hygiene
- systemic complications
- inadequate interarch distance
Advantages and disadvantages (Morrow, Dodge, Crum, Thayer, Miller, Toolson)
1. Advantages:
a. preservation of alveolar bone (Crum: 8x more bone loss over 5 years with
conventional dentures). (Atwood & Tallgren) CD wearers suffered irreversible bone loss
especially in the first year at the rate in the mandible being four times that in the maxilla.
(Miller) alveolar bone resorption is dependent upon three variables which are: 1) the
character of the bone, 2) the health of the individual, 3) and the amount of trauma to
which the structures are subjected.
b. proprioception is maintained (Thayer). Aids in directional sensitivity; dimensional
discrimination; canine response; tactile sensitivity. Lit review: (Manly) avg. threshold of
sensitivity to a load was ten times as great in denture wearers as in dentulous patients.
(Loiselle) discrimination was better in overdenture patients and that anterior teeth were
more sensitive than the posterior teeth.
c. Greatly enhanced stability (Dodge)
d. positive retention
e. VDO in maintained
f. CR is easily recorded and preserved
g. Lip and face support
h. Cuspid protection
i. Psychological benefits security patient still has his teeth
j. Mastication
k. Postextraction comfort
l. Positive support and comfort
Use of attachments Dodge discusses the advantages and disadvantages of the Gerber,
Rothermann, and the Baker clip attachments.
Gerber 696 Stud type, matrix, patrix, resilient and non-resilient designs

Advantages:
- Resiliency compatible with tissue displacement under the denture.
- Patrix and matrix sections are replaceable
- Provides excellent support, stability, and retention

Disadvantages:
- Considerable space or height is required. Difficult to use in a short interocclusal
situation
- Complicated to place, must be positioned with a surveyor on a cast. A precision pickup
impression of the copings in the mouth is required, and the female unit must be
laboratory processed to the denture.
- It is relatively expensive due to the above precision procedures and the original cost of
the attachments.
- Plastic teeth must be used and they tend to wear excessively.
- Sometimes, the attachment must be placed lingual to the abutment tooth, which in turn
must be placed into the vestibule.
- Cleansing of the matrix may present a problem.
- Some torque is applied to the root due to the height of the attachment.

Rothermann short stud with a retaining groove. Retention provided by a C-shaped ring
designed so that the free ends of the clip engage the deepest portion of the retaining groove. The
stud comes with a central core of solder for easy attachment to the coping

Advantages:
- Shorter than the Gerber and can be placed in close-bite situations.
- Direction of insertion is not important. Strict parallelism is not required.
- Attachment of stud to coping can be done over a Bunsen burner.
- The female clip can be cold-cured with a pickup procedure.
Disadvantages:
- Too bulky for many situations and a plastic overtooth is required.
- It is awkward to position the C clip for pickup in the denture.
- It is easy to lock the arms of the clip in acrylic resin.
- There is no lead-in as the patient attempts to seat the denture.
- Frequent adjustment may be necessary and are difficult to perform.
- Breakage has been a problem.

The Baker clip Small U-shaped clip designed to snap over a piece of round wire.

Advantages:
- Very small. Can use a porcelain overtooth.
- The design is simple.
- Parallelism is not a factor.
- It is easily constructed.
- The cost is minimal
Disadvantage: if the clip becomes worn or broken, it has to be cut out of the denture
rather than simply unscrewed.

4. Abutment teeth selection and preparation (Morrow, Miller, Thayer, Ullo)

(Morrow) Evaluation from four standpoints:

- Periodontal status: mobility of the abutment tooth can be reduced by improving the
crown:root ratio, pockets can be surgically corrected.
- Caries: lesions must be restorable
- Position: optimal abutment distribution for one arch typified by two cuspid and two
second molar abutment. This rectangular distribution provides for maximum stability and
support of the restoration.
- Endodontics facilitates correction of unfavorable clinical situations, i.e. crown:root
ratios, esthetics, malpositioned teeth, latitude in the preparation of the teeth, and
correction of unfavorable tilt and contours in abutments may be enhanced by
endodontics.

Preparations should be tapered toward the incisal or occlusal surface. This will permit
development of coping contours which terminate in a rounded occlusal surface as advocated by
Miller. Chamfer-type margins should extent just beneath the gingival margin and should be
definite enough to permit accurate carving of the wax pattern.
5. Tissue preparation (Morrow, Thayer, Casey)
- periodontal preparation. The amount of attached gingiva is by far the most important
consideration and it must be greater than 1 mm. Testing of the tissue is done by probing the
sulcular area and observing if bleeding occurs. If light inflammation is present oral hygiene must
be improved or the zone of attached gingiva must be increased through grafting
- submusosal vital root retention. (Casey and Lauciello) Historical review of the first root
submersions in humans. The primary goal was to gain periodontal attachment. In situations
where the conventional overdenture approach is not advisable (poor oral hygiene, periodontitis,
caries, economics, etc.) the vital root submersion procedures may be a viable alternative.
Advantage: retained root and retarding the resorption of bone.
Disadvantage: possible loss of vestibular depth due to the surgical technique.
6. Technical consideration (Morrow)
- Immediate interim overdenture a conservative approach which enables the dentist to
implement a tooth-supported complete denture on a graduated basis, providing flexibility in
planning treatment to meet the changing requirements. An interim tooth-supported denture can
be converted to a more definitive prosthesis following a favorable response to treatment,
maintained as is for a poor prognosis, or converted to a conventional complete denture.
- Metal-based overdentures offer several advantages, including strength, which minimizes
postinsertion breakage. They are indicated for those patients whose previous denture experience
includes recurrent failure due to breakage.
- The metal base should be short of the reflection of the cast because all borders are finished in
acrylic resin. Chrome-cobalt alloys for maxillary cases, and type IV gold for mandibular ones
(adds weight). Contact with the copings should be at the incisal 1/3 only. Check with disclosing
wax.
- From Thayers article: Warren and Caputo (1975) compared stresses on teeth restored with
amalgam, cast dowel post and copings, tapered cast gold copings, bischof-dosenbach

attachments and ceka attachments: the amalgam restored teeth displayed the least amount of
stress.
7. Maintenance
- Fluoride application - Toolson study: NaF gel is an effective means to prevent recurrent caries
on the retained overdenture abutments. The periodontal health, while not optimal, was not
responsible for the loss of a significant number of abutments. However, there was a significant
loss of attached tissue between the 2- and 5-year recall. The satisfaction of the patients with
overdentures remained high. The quality of the retention and support was also maintained. This
study emphasized the importance of a thorough periodontal evaluation of potential overdenture
abutments. Finally, the patient should be motivated to properly maintain the retained teeth with
home care and understand the importance of periodic follow-up care by the dentist.
- Benefits of fluoride - (Derkson) 0.4% SnF2 is an effective agent in reducing the progress of
gingivitis around overdenture abutments
- Abstracts
41-001. Miller, P. A. Complete dentures supported by natural teeth. J Prosthet Dent 8:924928, 1959.
Purpose: "This article is written in 1959." It discusses that there are a large number of young
people between 18-30 who are edentulous, and that one out of every five Americans has lost all
of his teeth by the age of 40. At the age of 50, the ratio is 2 out of 5, and at the age of 70, 2 out of
4.
Discussion: Eating to the elderly people is considered the one recreation from which even the
bedridden patient can derive great pleasure if he or she has the "wear with all" with which to
participate. It is inevitable that resorption occurs when teeth are removed. The rate of resorption
depends on three things. The character of bone, the health of the individual and the amount that
traumas are subjected to. Ten years of clinical investigation show that weak teeth used as support
for denture prosthesis not only remain in position but that a number have regain a healthier
status.
Methods & Materials: The remaining teeth are prepared as full crown coverage with a shoulder
type preparation. The shoulder provides space for a porcelain or a plastic labial insert in the
thimble portion of the prostheses and makes an oversized lingual surface unnecessary. There is
one important difference in preparation the normally flattened occlusal portion of the abutment
teeth should be rounded or parabolic in form.
Such a preparation permits the stresses of occlusion to be directed along the long axes of the
abutment teeth allows for some movement of the denture. The abutment tooth plays no part in
the retention of the denture; it acts as a stabilizer. Frictional retention is not wanted; using the
teeth for more than support of the denture will shorten their life. Retention of the denture is by
interfacial adhesion between the tissue side of the denture and the mucosa.
Thin wall (26 gauge) castings (copings) are made to cover the prepared abutment teeth and
cemented to place. All exposed tooth surfaces should be covered in an effort to prevent future
carious lesions from developing.
After approval of the try-in, the thimbles are removed from the wax denture and cemented to

the master cast. It is important that the thimbles be fixed to the master cast during fabrication
procedures to prevent seepage of resin into the inside of the thimbles. A malrelation of the
thimbles to the abutment teeth and the finished denture will result if this step is neglected.
Summary: Retaining teeth permit the stresses of occlusion to be borne partially by the teeth, thus
reducing the abuse, which the alveolar process and the mucoperiosteum undergo when dentures
are worn. By reducing the trauma to the mucosal tissues, it is reasonable to expect that resorption
of the alveolar process will be lessened.
41-002. Morrow, R. M., et al. Tooth-supported complete dentures: An approach to
preventive prosthodontics. J Prosthet Dent 21:513-522, 1969.
Purpose: This article is a technique article. It discusses the usefulness of utilizing abutment teeth
in the support of complete dentures. By maintaining teeth the alveolar ridge is less likely to
resorb.
Highlights:
I. Advantages of Tooth Supported Dentures.
1. Soft tissue of residual ridge receives less abuse since abutment teeth provide support.
2. More horizontal stability.
3. Increased vertical stability.
4. Excellent patient acceptance.
5. Natural teeth unacceptable for conventional dental use are acceptable for tooth supported
dentures.
II. Indications and Contraindications to the Tooth Supported Denture.
A. Indications
1. When patient presents with 4 or less retainable teeth.
2. Patient presents with maligned ridges.
3. Stability and/or retention of conventional dentures will be a problem.
4. Unfavorable tongue position, muscle attachments, and residual ridges.
5. Dentulous arch opposing a potentially edentulous arch.
B. Contraindications
1. Patient not motivated to maintain good oral hygiene.
2. Patient has numerous systemic problems.
3. Inadequate interarch distance.
III. Steps in Construction of Tooth Supported Denture.
1. Selection and preparation of abutments. A four step process.
a. Evaluate the periodontal status of proposed abutments.
2. Mobility: evaluate crown: root ratio
3. Consider periodontal surgery for pocket elimination.
4. Abutment preparations should taper toward the occlusal or incisal surface.
5. Chamfer margins are placed just below the gingiva.
a. Evaluate for caries.
b. Position of abutments and their relationship to each other.
6. Optimal abutment distribution: 2 canines and 2 second molars per arch.
7. Rectangular distribution provides the best stability.
8. A single abutment may be used.
9. Approximating abutments make cleaning difficult therefore avoid approximating abutments.

a. Endodontics
10. Restoration of abutment(s) with gold copings.
11. Metal base complete denture inserted over the abutments.
a. Provides an accurate base upon which jaw relations can be made.
b. Provides a precise adaptation of the abutment copings to the metal denture base
IV. Postinsertion instructions
1. remove dentures each night
2. Brush dentures after each meal with a soft toothbrush.
41-003. Morrow, R. M., et al. Immediate interim tooth-supported complete dentures. J
Prosthet Dent 30:695-700, 1973.
See section 26 Immediate Dentures for this abstract
41-004. Dodge, C. Prevention of complete denture problems by use of overdentures. J
Prosthet Dent 30:403-411, 1973.
Retaining roots of selected key teeth has demonstrated advantages over the use of complete
dentures:
1. Greatly enhanced stability. Anterior-posterior and lateral slipping and sliding are eliminated.
- Positive retention. Periodontal bone remains relatively intact. Tallgren has reported that the
anterior mandibular ridge resorption may be as much as four times that which occurs in the
maxilla.
- Proprioception. Provides an awareness of jaw-space relationships. It is impaired, if not lost
entirely when the teeth are extracted.
- Vertical dimension loss of bone is avoided.
- Lip and face support. Teeth do not disappear from view due to alveolar resorption.
- Psychological benefits. As long as the roots are preserved, the patient experiences a sense of
security and a feeling that he still has his teeth.
- Ability to masticate food seems to be better.
- Postextraction comfort. The common denture sore spots that often follow total extraction are
greatly diminished, because the immediate denture is resting on solid supports during this
postoperative period.
Types of attachments:
1. The Gerber attachment: A stud type of unit, consisting of male and female sections, and it is
available in resilient (containing a replaceable ring), and nonresilient designs.
Advantages - Can readily replace male or female attachments by unscrewing the worn unit.
Disadvantages - It must be positioned with a paralleling instrument or surveyor on a cast.
Requires considerable interocclusal distance. Some torque is applied to the root due to the height
of the attachment.
The Rotherman attachment: A short stud with a retaining groove. Retention is provided by a Cshaped ring or clasp designed so that the free ends of the clip engage the deepest portion of the
retaining groove. The stud comes with a central core of solder for easy attachment to the coping.

Advantages - Strict parallelism is not essential.

Disadvantages - To bulky for many situations. Adjustments are difficult. Breakage is a problem.
The Baker clip attachment: A small U - shaped clip designed to snap over a piece of round wire.
Advantages - It is very small. Parallelism is not a factor. Cost is minimal. It is easy to clean.
Disadvantages - If the clip worn or broken, it has to be cut out of the denture rather than simply
unscrewed.
Retention of roots makes possible a denture which provides support, retention, stability, and
comfort superior to that of a complete denture.
41-005. Thayer, H. H. Overdentures and the periodontium. DCNA 24:369-377, 1980.
Discussion: Preserving the teeth or the roots preserves the periodontal ligament. The periodontal
ligament supports the tooth, provides proprioception in directional sensitivity, dimensional
discrimination, tactile sensitivity to load, and canine response.
Manly et al found the average tactile sensitivity to load threshold for denture wearers was 10
times that of natural teeth. Pacer and Bowman found that patients with overdentures were better
able to discriminate occlusal forces. Kruger and Michel found that canines possessed a greater
number of neurons than any other teeth. Kawamura found that the anterior portion were more
sensitive than the posterior portion of the mouth.
Crum and Rooney showed that conventional denture patients had 8 times more loss of
mandibular alveolar bone than those with mandibular overdentures. Atwood and Tallgren found
that mandibular alveolar bone loss rate was 4 times more than in the maxilla. Carlsson found
reduced stress from the use of a tissue bar (Dolder Bar) in partial dentures compared to
conventional RPD.
Lang and Lowe states that 2mm of keratinized tissue and 1mm of attached tissue were needed
to maintain gingival health. Three signs to assess the quality and quantity of the gingiva are: 1.
Adequate width of attached tissue. 2. Bleeding on probing. 3. Free gingival margin is mobile.
In 1975, Warren and Caputo found the design of an amalgam-restored tooth displayed the
least amount of stress in a photoelastic study. In 1977, Thayer and Caputo found the Dolder Bar
exhibited more cross-arch involvement than the Zest anchor and allowed occlusal forces to be
shared between the abutments. In 1979, Thayer and Caputo found the Hader Bar exhibited more
apical force than the Dolder Bar and less torquing force than the King-connector. All tissue bars
exerted more stress on the contralateral side of the arch than did the stud and conventional
designs. This indicated the tissue bar shared the occlusal forces contralaterally and protected the
periodontium more equitably.
Patients must clean all exposed dentin and use 0.4% stannous fluoride daily.
41-006. Crum RJ; Rooney GE Jr. Alveolar bone loss in overdentures: a 5-year study. J
Prosthet Dent 40(6):610-3, 1978.
Purpose: To demonstrate less alveolar bone reduction in patients with complete maxillary and
mandibular overdentures compared to patients with maxillary complete dentures and mandibular
complete dentures.
Materials and Methods: 16 men aged 46-67 who had all their natural teeth re-extraction were

studied for 5 years after extraction. Two groups of eight men, each had 1)pre-extraction 2)3
weeks after extraction and 3)1 year post extraction cephalometric radiographs. Eight (group 1)
were treated with complete maxillary dentures over mandibular overdentures and eight (group 2)
were treated with maxillary and mandibular complete dentures. Overdenture teeth had root canal
treatments and were reduced 1.5 mm above gingival line with access sealed with amalgam.
Seven radiographs were made for each patient and casts were made for analysis at the same time
intervals as the radiographs.
Results: A 5-year clinical study showed that patients treated with complete maxillary dentures
and mandibular overdentures demonstrated less vertical alveolar bone reduction than patients
with complete maxillary and mandibular dentures. Patients in the control group exhibited a mean
vertical loss of 5.2mm of alveolar bone in the anterior part of the mandible and a mean vertical
loss of 1.7mm in the anterior part of the maxillae. The reduction in height of the anterior part of
the mandible for the overdenture group was 0.6 mm, which represents eight times more bone
loss in the patients with complete dentures. The bone loss in the maxillary process was similar in
both groups.
41-007. Derkson GD, and MacEntee, MM. Effect of 0.4% stannous fluoride gel on the
gingival health of overdenture abutments. J Prosthet Dent 48: 23-26, 1982.
Purpose: To observe the therapeutic effects of a o.4% SnF2 gel on the periodontium and tooth
structure of overdenture abutments.
Materials and Methods: This study the involved the participation of 17 patients:
Abutment teeth were prepared and dentures fitted according to technique described by Lord
and Teel. All patients wore their dentures comfortably during the day and removed them at night.
A double-blind crossover experimental design was used, after the initial exam, i.e. Group A used
0.4% SnF2 gel x 6 months and Group B used applied a similar but nonfluoridated gel. Then a
second examination was performed and the gels were exchanged with both groups applying the
alternative gel for another 6 months.
The final oral exams were performed after 1 year from the start of the study. The disease
activity was measured by one practitioner who evaluated, crevicular fluid production, gingival
pocket depth, width of attached gingiva, gingival inflammation, plaque accumulation, and
resistance of tooth surfaces to probing.
Results: Only 12 of the patients completed the study. The data was collected from a total of 34
teeth evaluated from these patients. Each patient had between two and four abutment teeth.
Overall results showed that after a 6 month application of the 0.4% SnF2 gel the there was a
significant improvement (i.e. the there was a reduction in fluid) of the crevicular fluid
measurement (CFM) scores and in the gingival index (GI) scores than obtained with the
nonfluoridated gel. The other variables, plaque index, pocket depth, attached gingiva, or caries
were not altered significantly.
Conclusions: This study showed that the 0.4% SnF2 gel was an effective agent in reducing the
progress of gingivitis around overdenture abutments.
41-008. Toolson, L. B. and Smith, D. E. A five-year longitudinal study of patients treated
with overdentures. J Prosthet Dent 49:749-756, 1983.

Problem: Overdentures have been documented by several authors to be associated with

periodontal disease and recurrent caries because of teeth are retained under a denture.
Purpose: To study the longitudinal changes that occurred with patients who have worn an
overdenture for a 5-year period. The effectiveness of fluoride to prevent caries, the periodontal
health of the abutments, along with problems with the prosthesis and patients satisfaction were
all assessed.
Materials and Methods: 54 of 89 patients (29 women and 25 men) returned for the 5-year recall.
133 overdenture abutments were examined. Areas of interest included: (1) patient satisfaction
with prosthesis, (2) periodontal health of overdenture abutments, (3) effectiveness of fluoride gel
to control caries, (4) quality of retention, stability, and occlusion of the dentures.
Results: Fluoride. 16 of 54 patients were using neutral pH NaF gel daily. 35 of 36 teeth had no
caries. The group not using fluoride had 94 teeth, of which 20 had caries.
Periodontal health of abutments. Attached tissue decreased significantly between the 2- and 5year recall examinations. The plaque index scores were not elevated. Fluoride use raised the
plaque score.
Patient satisfaction, support, retention, and occlusion of the dentures. Patient Denture
Satisfaction Questionnaire Scores remained at very acceptable levels, along with the evaluation
for support, retention and occlusion of the dentures.
Conclusion: Fluoride gel is an effective means to prevent recurrent caries on the retained
overdenture abutments. The periodontal health, while not optimal, was not responsible for the
loss of a significant number of abutments. However, there was a significant loss of attached
tissue between the 2- and 5-year recall. The satisfaction of the patients with overdentures
remained high. The quality of the retention and support was also maintained. This study
emphasized the importance of a thorough periodontal evaluation of potential overdenture
abutments. Finally, the patient should be motivated to properly maintain the retained teeth with
home care and understand the importance of periodic follow-up care by the dentist.
41-009. Ullo, C.A., and Renner, R.P. Design considerations for a removable partial
overdenture. Compend Contin Educ Dent 5:15-19, 1984.
Purpose: To examine the design criteria for successful removable partial overdentures.
Subject: Theoretical designs of a Kennedy Class I RPD incorporating an abutment root for use in
a removable partial overdenture.
Methods and materials: Selection of abutments should consider 1)periodontal status, 2)
morphology of the root canal system, 3) axial inclination of root, 4) root length, and 5) dental
arch position. The use of an overdenture abutment can effect changes in fulcrums and shift the
axis of rotation for the RPD. The Kennedy Class I RPD can effectively be converted to a
Kennedy Class II or III depending upon the number and location of overdenture abutments
selected. Intracoronal attachments may be utilized, but must provide the proper path of insertion
in relation to the design of direct retainers (clasps) to avoid lateral displacement during
insertion/removal.
Results: Use of partial overdenture abutment can help preserve alveolar bone, and help absorb
occlusal forces that otherwise would be fully dissipated through soft tissue into bone. Proper case
selection and design criteria are essential for success.
Conclusion: Although the application of overdenture techniques to RPDs may be clinically

appropriate in a relatively small number of cases, such treatment can be a practical alternative to
conventional therapy.
41-010. Casey, D, M. and Lauciello, F. R. A review of the submerged root concept. J
Prosthet Dent 43:128-132, 1980.
Purpose: The purpose of this article is to describe the historical evolution of the submerged root
concept and to chronologically review the available literature on this subject.
Discussion: Over the years there have been many reports showing that roots which were
fractured and left behind during extractions may be retained in the alveolar bone with no
evidence of pathosis. In fact, most retained roots have been shown to actually remain vital. In
1942 Bevelander studied the histological tissue reactions to experimental root fracture in dogs. In
1947 Glickman and associates histologically described the healing of postextraction wound with
the presence of retained root remnants in rats. They reported that in some rats pulp vitality was
retained in roots that were deep. In 1959 Simpson examined a number of retained roots in
humans and suggested that root fragments, which were originally unaffected, could be safely left
in position. In 1960 Helsham reported on a clinical supply of 2000 patients referred for removal
of retained roots that a small percentage of retained roots caused symptoms an any demonstrable
pathologic changes. In 1973 Herd reported on 228 retained roots removed from 171 patients. He
found 163 of these roots to have vital pulp tissue with no inflammation. The first published
report of intentional root submersion was by Bjorn in 1961. Bjorn excluded epithelial
downgrowth by severing the maxillary canine crowns on "a number of dogs" on whom he had
surgically produced labial periodontal defects 6 months prior. Results were not totally clear. In
1965 Bjorn and associates extended his previous study to humans. He cut off the crown of the
tooth at the gingival margin leaving several millimeters of tooth structure above the alveolar
crest. The primary goal of this study was to gain periodontal reattachment not to submerge roots
indefinitely. Nevertheless, this is considered the first report of root submersion in humans. In
1968 and 1969 Lam and Poon investigated the possibility of implanting cold-cure acrylic resin
roots. Results showed the rate and the amount of bone change were minimized in the region of
the implanted resin roots. According to Poe and associates in 1970 Howell reported a clinical
study of submerged endodontically treated roots, some of which had been under observation for
more than 10 years. Howells purpose was an attempt to preserve alveolar bone. He claimed
there was no apparent loss of bone in this long-term study and appears to be the first to utilize
this technique for bone preservation under complete dentures. In 1971 Poe and associates first
reported a study on vital root retention in dogs. Histologic examination showed that the vitality
of the root stumps was maintained in all dogs, and no evidence of periapical pathology was
present. In 1972 Lam reported on the use of acrylic resin, plaster of Paris, extracted teeth filled
with amalgam. There was definite delayed or altered resorption patterns, compared to the control
sites over periods up to 4 years. In 1972 Goska and Vandrake reported on a single human subject
having three endodontically treated roots submerged for a period of 2 years. No evidence of
either of systemic rejection were noted. In 1974 Johnson and associates reported on vital root
submersion in monkeys. No periapical pathology was observed. In 1974 Whitaker and Shankle
found higher success rate in the vital roots (12 of 19) than in the endodontically treated roots (3
of 17). The successfully submerged endodontically treated roots were associated with mild
pericoronal inflammatory response. This reaction was totally absent in all the successful vital
submersions.

In 1973 Sander discussed the advantages of root retention for the maintenance of alveolar
bone. He cited the main disadvantage of root submersion as the effect of the reduction in height
of the vestibule.
In 1974 Simon and Kimura extracted endodontically treated and reimplanted 30 roots in eight
patients. Many roots were showing signs of resorption, although clinically some of the patients
appeared to be maintaining alveolar bone. In 1974 article Levin and associates felt that retention
of roots in a vital state might not be the method of choice in human. In 1975 Simon and Kimura
histologically examined six roots from two patients. The roots had been submerged 22 and 30
months previously. The results showed root resorption and areas of ankylosis present in all roots.
In 1975 Guver reported two vital roots submerged in a human. After 27 months, three teeth
remained normal radiographically and clinically, and they maintained the alveolar ridge contour.
This was the first reported vital root submersion in humans. In 1976 Plata reported on a
histologic study of the regeneration of alveolar bone over submerged vital roots in the dog. In
eight of the 12 roots there was complete bone coverage after 12 weeks with the pulp retaining its
vitality in all roots. In 1977 Cook and association performed a study similar to Bjorns 1965
study, except that the submerged teeth were vital. Pulpal tissues associated with submerged roots
appeared vital without significant degenerative or inflammatory. Results coronal overgrowth, no
periapical inflammation, no pericoronal inflammation was found. In the second part of their
study, Gound and associates extracted 16 roots after endodontic therapy and sectioned and
contoured to 2 to 3 mm below the alveolar crest. In 1978 Welker and associates reported on 12
roots submerged in six patients. Eight were vital and four nonvital. Dentures had been worn over
the roots for periods up to 51months. All patients had been termed clinically successful.
Conclusion: The obvious need to preserve alveolar bone for complete dentures has led to the
overdenture concept. Studies reviewed indicate that noninfected vital roots completely
submerged within the alveolus may be an expedient and inexpensive way of preserving alveolar
bone for the support of complete or removable partial dentures. The main disadvantage was the
loss of vestibular depth due to the surgical technique that is involved.